Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? A qualitative study

Abstract

While Primary Care Physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. This study explores European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. A multicentre European qualitative study, based on an online survey with open-ended questions asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. A total of 158 PCPs completed the questionnaire. The main themes were: where patients' descriptions did not suggest cancer; when distracting factors reduced PCPs' suspicions of cancer; when patients' hesitancy delayed the diagnosis; where system factors hampered the diagnostic process; when PCPs felt that they had made a mistake; and inadequate communication. The study identified six overarching themes which need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation shows how the themes relate to each other.